5.5.4 Restrictive Physical Intervention

SCOPE OF THIS CHAPTER

This chapter refers to the management of the behaviour of every looked after child. Whilst the use of restrictive physical intervention tends to relate to a small group of children in residential care, all staff and carers should be familiar with this procedure.

1. Planning for Children

As part of the assessment and planning process for all children, consideration must be given to whether Physical Intervention may be necessary in managing behaviour.

If Physical Intervention may be necessary, the circumstances that give rise to it and the strategies for managing it should be outlined in the child’s Placement Information Record.

This plan should outline the circumstances that may give rise to the use of Physical Intervention, the methods which are known or likely to be effective and other arrangements for its use.

It is also important to determine whether there are any medical conditions which might place the child at risk should particular techniques or methods of physical intervention be used. If so, this must be drawn to the attention of those working with or looking after the child and it must be stated in the child’s Placement Information Record. If in doubt, medical advice must be sought.

The absence or existence of such a plan does not prevent staff/carers from acting as they see fit when confronted with unforeseen likely injury or damage to property, so long as the actions taken are consistent with the principles and procedures contained in this chapter.

2. Definition of Physical Intervention

There are four broad categories of Physical Intervention:

2.1Restraint

Defined as the positive application of force with the intention of overpowering a child. Practically, this means any measure or technique designed to completely restrict a child's mobility or prevent a child from leaving, for example:

Any technique which involves a child being held on the floor ('Prone Facedown' techniques may not be used in any circumstances);

Any technique involving the child being held by two or more people;

Any technique involving a child being held by one person if the balance of power is so great that the child is effectively overpowered; e.g. where a child under the age of ten is held firmly by an adult;

The locking or bolting a door in order to contain or prevent a child from leaving.

The significant distinction between this first category and the others (Holding, Touch and Presence), is that Restraint is defined as the positive application of force with the intention of overpowering a child. The intention is to overpower the child, completely restricting the child's mobility. The other categories provide the child with varying degrees of freedom and mobility.

2.2 Holding

This includes any measure or technique which involves the child being held firmly by one person, so long as the child retains a degree of mobility and can leave if determined enough.

2.3 Positive Touching

This includes minimum contact in order to lead, guide, usher or block a child; applied in a manner which permits the child quite a lot of freedom and mobility.

2.4 Presence

A form of control using no contact, such as standing in front of a child or obstructing a doorway to negotiate with a child; but allowing the child the freedom to leave if they wish.

Restraint also includes restricting the child’s liberty of movement. Restriction on liberty of movement can involve adaptations to the environment such as using high door handles or removing physical aids, but it also refers to behaviour support strategies such a requiring a child to take ‘time out’ in a specific area of the home, asking a child to spend time away from the group to regain control of their behaviour (i.e. if a child is struggling to maintain a socially acceptable level of behaviour at the meal table, asking them to move away from the group to another area, can be defined as restricting their liberty of movement). Where there is no need to use restrictive physical intervention (i.e. the child goes willingly once instructed to do so) a record of the incident must still be recorded (see recording and reporting). This is to ensure the intervention can be monitored and to ensure that children are not be scapegoated or unduly being isolated from the group.

Where the likely application of this strategy is a reasonable assumption due to a child’s previous behaviour or level of emotional needs, this should be included in the EHC plan/Care plan. This should be monitored as part of the normal review process. This strategy should be clearly recorded on the child’s Individual Behaviour Support Plan. In this instance, there is no requirement to complete an incident report, unless the behaviour displayed is new, unusual or falls under any other category of incident.

If a child has an EHC plan or statement of educational need in which a specific type of restraint/ physical intervention is used as part of the day to day child’s routine, the home is exempted from the recording requirement. Where these plans provide for a specific type of restraint that is not for day to day use, the restraint used must be recorded. Any other restraint used must always be recorded.

3. Who may use Physical Interventions?

Trained staff should only use Physical Intervention if they have undertaken approved training. However, where staff/carers have not undertaken such training, the use of minimum force may be justified if it is the only way to prevent serious injury, to self or others.

In these circumstances, staff must always act in a manner consistent with the values and principles set out in this manual. Any incidents of the use of restraint must be reported immediately to the child’s social worker and supervising social worker.

Any intervention used must:

Not impede the process of breathing;

Not intentionally inflict pain or injury or threaten to do so;

Avoid vulnerable parts of the body, e.g. the neck, chest and genitalia;

Avoid extending the joints beyond the normal limits or range of motion (hyperextension or hyperflexion), and pressure on or across the joints;

Not employ potentially dangerous positions.

4. Criteria for Using Physical Interventions

There are different criteria for the use of Restraint and Holding, Touching and Physical Presence/proximity.

Restraint may only be used where there is likely significant injury or serious damage to property. Positive Touching or Presence are less forceful and less restrictive and may be used to protect children or others from injury;

Before any other form of Physical Intervention is used, all of the following principles must be applied:

For the intervention to be justified there must be a belief that significant injury is likely in the predictable future;

The intervention must be immediately necessary;

The actions or interventions taken must be a last resort;

Any force or intervention used must be the minimum necessary to achieve the objective.

If a young person requires a restriction of their liberty to keep them safe from significant risk of harm there must be clear evidence of a planning meeting with the placing authority to consider the appropriateness of the placement. It may be recognised that this is a process of testing and an agreement regarding strategies will be set and reviewed in conjunction with the local authority, this will need to be clearly documented and any agreement must not conflict with regulations regarding ‘Deprivation of Liberty’.

5. Locking or Bolting of Doors

It is acceptable to use mechanisms or modifications to a children’s home or foster home which are necessary for security, for example on external exits or windows, so long as this does not restrict children’s mobility or ability to leave the premises if it is safe for them to do so.

In children's homes it is also acceptable to lock office or storage areas to which children are not normally expected to gain access.

If such mechanisms are used they must be outlined as follows:

In children’s homes, if any such mechanisms or modifications are used, they must be set out in the home’s Statement of Purpose and the arrangements for their use set out in the home’s Staff Handbook.

In foster homes, if any such mechanisms or modifications are used, they must be agreed by the manager of the fostering service and set out in the Foster Care Agreement.

Locking of external doors, or doors to hazardous materials, may be acceptable as a security precaution if applied within the normal routine of the home.

6. Timeout and Withdrawal

Where the following measures are used in children’s homes or foster homes, they must be approved and set out in writing.

In children’s homes, they must be set out in the home’s Statement of Purpose or in Behaviour Management Plans (as part of the Placement Information Record) for individual children.

In foster homes, foster carers are expected to following the guidance in line with attachment style parenting. Withdrawal involves removing a child from a situation, which places the child or another person at risk of injury or to prevent damage to property, to a location where s/he can be continuously observed or supervised until ready to resume usual activities.

7. Medical Examination

In children’s homes where Physical Intervention has been used, the child, staff/carers and others involved must be given the opportunity to see a medical practitioner, even if there are no apparent injuries.

In other settings, where physical intervention is used, the child, staff/carers and others involved should be given the opportunity to see a medical practitioner if there are any apparent or reported injuries.

The medical practitioner, if seen, must be informed that any injuries may have been caused from an incident involving physical intervention.

Whether or not the child or others decide to see a medical practitioner must be recorded, together with the outcome.